Papers by Bernadette Richards
Social Science Research Network, Sep 13, 2018
Journal of Bioethical Inquiry, Mar 1, 2020
Social Science Research Network, Jul 11, 2019
PubMed, Dec 1, 2012
The conventional wisdom is that we are free to dispose of our organs at death and that they will ... more The conventional wisdom is that we are free to dispose of our organs at death and that they will be employed according to our wishes. However, this reflects neither the formal law nor medical practice. This article explores the theory underlying the principle of self-determination after death. It presents an overview of Australian law and the way that the law is interpreted in clinical practice. It then presents the results of a community survey on organ disposition, and identifies a gap between community expectations and the current operation of Australian law. It concludes with some specific recommendations for development of the law to align it more closely with contemporary community views.
Journal of Bioethical Inquiry, Oct 4, 2013
Bioethical questions within the law, especially those concerning life-saving treatment, often req... more Bioethical questions within the law, especially those concerning life-saving treatment, often require quick decisions. But litigation is notoriously slow and cumbersome. Such disputes are often moot by the time they reach an appellate court—one that can issue a decision of precedential value—because a decision by the court can have no practical legal effect on the controversy. While courts normally dismiss moot cases, there are some important exceptions. Famously, the U.S. Supreme Court in Roe v. Wade proceeded to decide the constitutionality of restrictions on abortion, even though the plaintiff’s baby had already been born (Roe v. Wade, 410 U.S. 113 (1973)). After all, “the normal 266-day human gestation period is so short that the pregnancy will come to term before the usual appellate process is complete. If that termination makes a case moot, pregnancy litigation seldom will survive much beyond the trial stage, and appellate review will be effectively denied” [125]. Roe is not unique in this respect. Traditionally, appellate courts have adjudicated moot bioethics cases in two main situations: (1) when the issues are of public importance and (2) when the issues are capable of repetition yet evading review. But, increasingly, appellate courts are abdicating their responsibility to decide moot cases satisfying these exceptions. In re Sheila W., 2013 WI 63; 348 Wis.2d 674, 835 N.W.2d 148, a July 2013 decision from the Wisconsin Supreme Court, is of interest because it illustrates a growing trend of appellate courts declining to address difficult and controversial bioethics issues. Sheila W. (Sheila) was a 15-year-old resident of Dane County, Wisconsin. In February 2012 she was diagnosed with aplastic anemia, a life-threatening illness in which a person’s immune system attacks her bone marrow, preventing the body from producing new blood cells. Sheila’s physicians gave her antibody treatments. After three days, however, Sheila’s red blood cell, white blood cell, and platelet counts remained very low. Her physicians determined that she needed blood transfusions. Without them, Sheila was at risk of infection, spontaneous hemorrhage, and cardiac arrest. In short, Sheila’s physicians concluded that, without blood transfusions, she would die. But Sheila and her family are Jehovah’s Witnesses who believe that God prohibits blood transfusions. Accordingly, Sheila’s parents refused to consent to blood transfusions. Moreover, Sheila’s parents thought that Sheila was mature enough to make her own decision. They told Sheila that they would support her decision whether to accept or refuse transfusions. Like her parents, Sheila also refused to consent to the transfusions. She told her attending physician that she “would rather die... than survive [with] the stigma Bioethical Inquiry (2013) 10:441–444 DOI 10.1007/s11673-013-9486-z
Journal of Bioethical Inquiry, Apr 20, 2017
The provision of healthcare was once relatively straightforward. Based upon the Hippocratic tradi... more The provision of healthcare was once relatively straightforward. Based upon the Hippocratic tradition, the doctor/patient relationship was not a partnership, rather there was an unequal relationship where an all knowing—and one would hope, all caring—doctor provided treatment in a manner consistent with their specific view of the world. There were few ethical or legal complexities and individual preferences were relevant only insofar as they impacted on the doctor’s clinical decision making. Medicine and the human condition have, however, moved on from this simpler time and there are deep complexities to be found at the intersection of law, religion and the provision of healthcare. This chapter explores this intersection and considers the ongoing struggle to respect the interests of all parties in the healthcare relationship, concluding that, despite the often competing priorities of healthcare providers, individual patients, regulatory regimes and religious organisations, there are a core set of principles that are appropriately supported in our current regulatory framework. These include: respect for individual dignity and autonomy, freedom of choice, and the inviolability of human life. This conclusion will be supported through a consideration of five ‘salient principles’ raised by the Archbishop of Westminster and considered by the court in the complex decision of Re A (Children) (Conjoined Twins: Surgical Separation) [2001] 2 WLR 480.
Social Science Research Network, Dec 21, 2018
Demands for improved access to innovative therapies have prompted a discourse that claims patient... more Demands for improved access to innovative therapies have prompted a discourse that claims patients have rights to access treatments that may be of benefit, even if evidence that demonstrates safety and efficacy is lacking. This rights-based discourse is grounded in accounts of autonomy and assertions claiming that the state ought to not interfere with the free choices of patients and clinical decision-making. In this essay, we scrutinise these arguments to defend the ethical and legal permissibility of interference in contexts where the uncertainty of benefit and potential for harm creates vulnerabilities that undermine patient capacity for self-determination. In support of this argument, we draw on two theoretical approaches to explore the limits of autonomy in innovative contexts and analyse the legal bases of the rights-based discourse. We then apply this analysis to the case example of stem cell transplantation as an innovative treatment for multiple sclerosis.
Social Science Research Network, Oct 18, 2018
As rational adults, we are free to elect what is (or is not) done to our bodies. However, this st... more As rational adults, we are free to elect what is (or is not) done to our bodies. However, this strong freedom does not extend to the borders of life. Control over the uses of our biological material is constrained and uncertain at law. Our article examines the legal condition of embryos and organs: how law conceptualises them and regulates their uses.
Social Science Research Network, Jul 11, 2019
Social Science Research Network, Oct 18, 2018
Social Science Research Network, Oct 18, 2018
The legislative framework for adult residential care, community care and support for carers is in... more The legislative framework for adult residential care, community care and support for carers is in adequate, often incomprehensible and outdated. It remains a confusing patchwork of conflicting statues enacted over a period of 50 years (Law Commission 2008, 10).
BMC Medical Ethics, Mar 23, 2022
The development and deployment of medical devices, along with most areas of healthcare, has been ... more The development and deployment of medical devices, along with most areas of healthcare, has been significantly impacted by the COVID-19 pandemic. This has had variable ethical implications, two of which we will focus on here. First, medical device regulations have been rapidly amended to expedite approvals of devices ranging from face masks to ventilators. Although some regulators have issued cessation dates, there is inadequate discussion of triggers for exiting these crisis standards, and evidence that this may not be feasible. Given the relatively low evidence standards currently required for regulatory approval of devices, this further indefinite reduction in standards raises serious ethical issues. Second, the pandemic has disrupted the usual operations of device representatives in hospitals, providing an opportunity to examine and refine this potentially ethically problematic practice. In this paper we explain and critically analyse the ethical implications of these two pandemic-related impacts on medical devices and propose suggestions for their management. These include an endpoint for pandemic-related adjustments to device regulation or a mechanism for continued refinement over time, together with a review of device research conducted under crisis conditions, support for the removal and replacement of emergency approved devices, and a review of device representative credentialling.
Medical Education, Apr 7, 2020
European Journal of Health Law, Jan 16, 2018
Healthcare professionals, legal professionals, patients, scholars and members of Research Ethics ... more Healthcare professionals, legal professionals, patients, scholars and members of Research Ethics Committees all hear the term "informed consent" and seem to assume a common meaning. It is a phrase often said and widely accepted, but what does it really mean? This thesis challenges the doctrine of "informed consent" and argues that it lacks coherence and fails in its foundational goal: to protect the autonomous patient. It argues that "informed consent" is a misnomer; that the process under consideration is not about the consent to treatment, rather it is about individual choice.
Elsevier eBooks, 2008
Human organ and tissue transplantation has proven to be an economically viable and successful the... more Human organ and tissue transplantation has proven to be an economically viable and successful therapy that extends life expectancy and improves the quality of life of individuals with certain severe medical conditions or irreversible organ failure. The demand for ...
Social Science Research Network, Mar 16, 2021
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Papers by Bernadette Richards